The Southeast Tech Diagnostic Medical Sonography Program is accredited by the

Commission on Accreditation of Allied Health Education Programs (CAAHEP)

upon the recommendation of the

Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-DMS).

CAAHEP (caahep.org) Commission on Accreditation of Allied Health Education Programs 25400 U.S. Highway 19 North, Suite 158 Clearwater, FL 33763 Phone: 727-210-2350

JRC-DMS (jrcdms.org) Joint Review Committee on Education in Diagnostic Medical Sonography 6021 University Boulevard, Suite 500 Ellicott City, MD 21043 Phone: 443-973-3251

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DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM INFORMATION

Diagnostic Medical Sonography (DMS) uses high-frequency sound waves to produce dynamic visual

images of organs, tissues, and blood flow states within the body. Sonographers use high-tech equipment

including an ultrasound transducer, which emits pulses of high frequency sound waves into the body, and

processing components to display the reflected signals as images and quantitative data. Sonographers

provide one-on-one care to a variety of people from embryonic life to the end of life, from the healthy to the

critically ill. The sonographer’s findings are interpreted by physicians to assess and diagnose medical

conditions. Some sonographers also assist physicians or surgeons during invasive or surgical procedures.

Diagnostic Medical Sonographer Duties include:

Review and assess the patient’s medical records as they relate to required examination.

Prepare and inform patient in regard to sonographic procedures and expectations.

Assume responsibility for the safety of the patient during the sonographic examination

Maintain patient privacy and confidentiality in compliance with legal (HIPAA) regulations.

Prepare and maintain diagnostic imaging equipment.

Operate equipment to obtain optimal diagnostic images and data.

Apply independent judgment during the sonography examination to ensure appropriate anatomical, pathological, and clinical conditions are accurately captured.

Analyze images and data for quality and comprehensive assessment.

Summarize diagnostic information for physician interpretation and use computer/software for documentation activities and report generation.

Important Qualities of Sonographers:

Integrity – Must be honest and ethical. Must be reliable and responsible.

Interpersonal skills – Must be able to communicate clearly and interact appropriately and effectively with patients and medical professionals, regardless of their duress or ability to cooperate.

Detail oriented – Must be able to follow protocols, execute exact measurements, and provide proper documentation. Must be able to accurately interpret instructions from physicians or other medical professionals.

Critical thinker- Must have the ability to make clear, reasoned judgments, even under stress.

Technical skills – Must understand how to operate complex sonographic equipment to provide useful diagnostic information to physicians and other medical professionals. The Sonographer must be able to conceptualize and comprehend multi-dimensional relationships of anatomic structures and their appearance on a two-dimensional screen.

Independence – Must be able to accomplish tasks with little direct supervision in a timely manner.

Professional Growth - Must be committed to life-long learning and professional growth. Must understand sonography and medicine are constantly changing and require participation in continuing medical education opportunities.

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Diagnostic Medical Sonographers are required to:

Communicate effectively with patients and other medical professionals via speech, reading, and writing.

Consistently visualize images from monitors; distinguish multiple shades of gray and multiple colors.

Routinely discern small numbers and controls on medical equipment in dimly lit conditions while being attentive to detail.

Regularly distinguish audible sounds.

Regularly use a high degree of hand-eye coordination to manipulate equipment, while simultaneously inputting data into a machine or working with a patient.

Have full use of both hands, wrists and shoulders; regularly reach with arms and hands.

Regularly use hands and fine finger dexterity to handle and feel.

Regularly stand up to 80% of the time.

Frequently walk, and sit.

Frequently bend/stoop, kneel and squat.

Routinely lift and/or move or use pushing/pulling force up to 60 pounds.

Assist patients on and off examining tables.

Interact compassionately and effectively with the sick and injured.

*Source: www.bls.gov, www.sdms.org, local job descriptions

Environment of Profession for Sonography:

Sonographers complete most of their work at diagnostic imaging machines in dimly lit rooms, but they also

may perform procedures at patients’ bedsides. Sonographers may work within a hospital, out-patient clinic

facility or on a mobile unit. Hours are generally daytime hours, but evening, night, weekend, and holidays

coverage may be required. “On-call” hours may be expected for emergency procedures. Sonographers often

work alone with patients, but coordinate workload as part of a team. Sonographers report to interpreting

physicians, emergency physicians, and/or surgeons, and may often perform sonography exams under their

direct observation. Most employers will require the appropriately related registry credential either upon hire or

shortly thereafter. (ARDMS or ARRT)

Risks and work conditions for sonographers:

Work-related musculoskeletal disorders affect a large number of sonographers, particularly those with heavy workloads and those who have been in the profession for a long time.

Sonographers and student Sonographers will have extensive, direct patient contact that will likely include invasive procedures, use of needles and exposure to blood and body fluids.

Sonography is usually performed in small, dark exam rooms, at patient bedsides, in emergency rooms, intensive care units, or operating rooms.

Sonographers may be required to work various shifts to provide 24-hour coverage, including early morning, day, evening and night shifts. Shifts may be 8, 10, or 12 hours in length. Some facilities will also require sonographers to be on call.

Sonographers and student sonographers must be able to tolerate physical and emotional stress and continue to function effectively and compassionately with the sick and injured.

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General expectations of Sonography Students

Sonography is a profession requiring a mastery of a significant amount of knowledge and technical skills. In

addition to fulfilling all academic requirements, students are required to display behaviors consistent with

accepted standards of professionalism. As an extension to the policies of Southeast Tech and the Health

Handbook, the following items identify the expectations of sonography student behavior:

Attendance is considered mandatory for each course lecture session and laboratory session. Students are expected to notify instructors prior to absence and promptly complete any missed work. Excessive absences may result in a student’s inability to interview or attend the clinical internship.

The primary means of communication with students, outside of class, is the Southeast Tech email system. Students are expected to check Southeast Tech email frequently.

Professional language is expected at all times. Voice levels should be moderated, and appropriate judgment should be used in the choice of words. No profane language will be tolerated. Tactfulness is expected.

Students are expected to maintain confidentiality at all times in the classroom, in the skills lab, and in a clinical setting. This includes, but is not limited to, information learned verbally, in written format, or while scanning. Students are only permitted access to patient records that are relevant (patients involved in a procedure). Students must sign an agreement to maintain confidentiality which will be kept on file. Any breach of confidentiality will be considered grounds for immediate disciplinary action, including possible dismissal from the program.

Honesty in all communication is expected. Dismissal from the program may result if a student is dishonest, steals, cheats, comes to class/lab/clinical intoxicated, under the influence of alcohol or controlled substances, or inappropriate use of social media (including remarks about patients or sharing any patient information). Dismissal may also result from making disparaging remarks about your school, program, classmates, faculty members and/or staff.

Academic dishonesty includes, but is not limited to cheating, plagiarism, misrepresentation of student status, and resume falsification. Plagiarism includes, but is not limited to, the use by paraphrase or direct quotation, the published or unpublished work of another person without full and clear acknowledgement. This behavior will result in a zero for that work or an “F” for the course if unethical behavior has occurred before in the course or program.

Students are expected to access and review their transcript/course audit through STInet and monitor their requirements for graduation, including transfer courses. It is the student’s responsibility to register and pass all required courses. Students should reference the current program curriculum sheet.

Students are expected to spend twice the time outside of the scheduled class and lab time in preparation, study, review and practice for comprehensive learning and skill competency.

Students are encouraged to seek part time employment in a health care setting if it is necessary for a

student to be employed while attending Southeast Tech.

Professional Behavior and Social Media Policy

Socializing with faculty, preceptors, clinical instructors, clinical site sonographers, and ultrasound lab assistants while enrolled as a sonography program student is prohibited outside the normal educational environment ‘on-campus’ and in a clinical setting. It is important for health care students to behave in a professional manner and realize their behavior may be misinterpreted by those they serve. Unprofessional behavior may include, but is not limited to communications (verbal, voice inflections, non-verbal actions or stances, postings, etc.) which may potentially compromise the health care relationship with patients, family members, staff, or physicians, or which may compromise the clinical affiliation relationships, or those that may violate legal or ethical standards.

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Students may not be in possession of their cell phones while in a clinical setting. Cell phone use is also prohibited during class and lab times.

Social Media

As students enter the health care professions, it is necessary to understand the effect social media may play on them personally and professionally. Communications/postings that may have taken place in students’ juvenile years may not be appropriate for their professional educational term or employment prospects.

Student “friending” or “following” of faculty, preceptors, clinical instructors, clinical site sonographers, and ultrasound lab assistants is prohibited.

Students are prohibited from posting comments regarding clinical experiences which can easily be interpreted as violation of HIPAA criteria and may result in termination from the program.

DMS Student Dress Code Policy

Whether we like it or not we are judged by our appearance. Health care institutions spend many dollars to

promote an image of professionalism. Patients (customers) expect a level of professionalism by the staff

providing their care. The clinical affiliates of Southeast Tech expect a professional, appropriate appearance and

demeanor that will maintain the organization’s public image, promote a productive work environment and comply

with health and safety standards.

Students will be entering the professional clinical environment within the program. Preparation for this transition

includes observing the following items of the dress code policy. These items are in addition to the dress code

policy as outlined in the Health Handbook.

Dress code while attending any DMS, CV, or HC course:

Southeast Tech program specific ‘Scrubs’ are required. Scrubs are to be sufficiently sized to allow patient care to be given without exposure. Necklines and

backsides are to be properly covered. Scrubs should be clean, non-wrinkled, and in good repair.

No caps of any kind are allowed.

Limited and conservative jewelry and cosmetics may be worn. (1 to 2 ear piercings maximum.) Dangling earrings or necklaces are prohibited. Artificial nails are prohibited.

Exposed body piercing, facial piercing or ear gauges are not allowed.

Any visible tattoos are to be covered.

Personal hygiene should limit body odor, including perfumes and colognes.

Smoke odor should not be detectable.

Additional Requirements for Dress Code in any Southeast Tech LAB:

Southeast Tech Scrubs are required in the lab. (No sweatshirts/sweaters, etc. may be worn over scrub top. Students may wear long or short sleeve white T-shirt under scrubs, and or add a lab coat if cold.)

Sturdy closed-toe shoes with socks must be worn. (No “uggs” or slippers, etc.)

Long hair should be drawn back in a neat pony-tail during lab.

Southeast Tech Student ID badge is to be worn during lab.

Students are required to have a lab coat available for lab sessions and for any Clinical course.

Students in violation of dress code will be asked to correct their transgression in order to join the classroom, lab, or clinical session.

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DMS Curriculum Sequence Rationale: From the start of the DMS program, students participate in ultrasound scanning labs in conjunction with didactic learning in the classroom. This continues from the first semester through the fourth semester. In the fourth semester, clinical observation hours are added with the didactic and laboratory hours. During the fifth and sixth semesters, students participate in a clinical practicum and didactic course work. The sequencing of the courses is designed to initially provide a strong anatomy and physics foundation for the program and initiate the student into the basics of ultrasound scanning. As the program continues, more in-depth study of pathology and physiology of the abdominal organs is conducted. The students improve scanning skills, protocol knowledge, and imaging quality throughout the remainder of the program, corresponding with the anatomical area studied in the didactic coursework. Lab skills learned in specific anatomical area are brought forward and applied to further assignments throughout the program. The principles of ultrasound physics and instrumentation are studied concurrently with the abdominal courses in the second semester. Students are required to successfully complete the ARDMS Sonography Principles and Instrumentation registry exam after completion of the Ultrasound Physics course. After study of the abdominal cavity, the didactic and laboratory courses concentrate on pathology and physiology of the female pelvic cavity, fetal development, and Obstetrical ultrasound. Peripheral vascular technology is introduced through didactic and laboratory courses at this point, also. The students continue to concentrate on scanning skills in these areas, as well as continuing to build on previous skill knowledge obtained from prior learning areas. Pathology, physiology and ultrasound scanning of the thyroid, breast, scrotum, neonatal head and spine, and musculoskeletal structures are also studied in the fourth semester, which continues to refine scanning skills of students and expand didactic learning in these areas. The didactic, laboratory and shadowing experiences are designed to prepare the students for the clinical experience of the final two semesters. This is the completion process of refining scanning skills, patient interaction, professional behavior and didactic review. Students are expected to successfully complete both ARDMS Abdominal and Obstetrics/Gynecology registry examinations prior to graduation. *Students must achieve a grade of C (80%) or higher in PHYS100 and all HC, CV, and DMS courses to continue in the program.

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DMS Clinical Internship Information

Clinical placement is determined only after the student has been observed safely and consistently

performing all required procedures in specified time frames.

Clinical Placement requires successful completion of all courses listed on the curriculum schedule prior to

the start of the clinical internship courses. The DMS Clinical Internship courses are: DMS 250, DMS 255,

and DMS 260.

The number of clinical sites in the Sioux Falls area and the state of South Dakota is extremely limited.

This means the student will more than likely have to move away from this area for the clinical internship

portion of this program.

Required relocation for the Clinical Internship may be great distances from Southeast Tech. For example,

Alaska, Virginia, Arkansas, and Nevada are often included in the available clinical site location list.

Students are expected to complete the clinical internship portion of the program with their original cohort,

unless the student is dismissed from the program for academic, behavioral, or other administratively

determined causes. Not accepting an available clinical site is considered as a withdrawal from the

program by the student.

Moving and living expenses incurred are the responsibility of the student.

No preference is given to students for any reason in the clinical site selection process, for example: family

situations, owning houses, etc. Students must be prepared to move to distant locations to complete the

clinical internship.

Students may have to compete with other students for desired clinical site positions. Selection of students

for site placement is determined by the personnel at the clinical site through an interview process.

Interview expenses are the responsibility of the student.

Students are not to have any contact with any potential clinical sites until given permission by the

program director. Any contact or solicitation of clinical sites by family or friends is also prohibited. Contact

with clinical site personnel for purposes of securing a clinical internship position may result in the student

forfeiting the opportunity to apply at that site, and may also result in dismissal from the program if this

infraction results in a particular clinical site declining or withdrawing from the site list.

Criminal Background Checks and Drug Screening are required before admission to the program as part

of the application process. Another background check will be required prior to the start of the clinical

internship at the student’s expense. Drug Screens may be requested at any time during the clinical

internship.

Physicals will be required before clinical placement.

Immunization records including Hepatitis B, Measles, Mumps, and Rubella (MMR), Tetanus and

Diphtheria and (Tdap) or titers will be required. A Titer, or immunization for, Varicella (Chicken Pox) will

be required. A current TB test will also be required. All immunizations and TB tests need to be completed

prior to the start of the fall semester of the second year when student clinical observation occurs. Current

seasonal influenza vaccination will be required by December 1st. .

Valid CPR “Health Care Provider CPR” Certification through the clinical internship will be required. A

copy of a valid CPR card must be submitted.

Health Insurance coverage will be required during the clinical internship. Proof of insurance must be

submitted.

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Clinical Site Selection Process and Policy

1. A list of approved sites shall be presented to the students upon its completion.

a. The list shall contain the number of sites no fewer than the number of students in the program

specialty.

b. At the very least, a tentative list shall be released no later than September 30 of the year prior to the

clinical period.

2. Site selection for the list is based on:

a. Specialty advisor approval with consideration on the number and variety of procedures, the amount and

types of equipment, and staffing.

b. Sites interest in having a student and in teaching.

c. Sites within the same cities as existing sites (from any of the programs).

d. Sites willing to take more than one student. This may be in more than one specialty area, or in the

same area. This will be subject to instructor approval of each specialty involved.

3. Changes in the list once it has been presented will be made only if an approved site needs to withdraw.

Replacement will be based on selection criteria set forth in this policy.

4. The student is NOT allowed to make contact with hospital/clinic personnel at any clinical site until approved

by the Program Director. Solicitation of clinical sites by family and friends is also prohibited. Failure to

comply with this policy may sacrifice the student’s opportunity to apply at the site.

5. Placement is determined by selection of the clinical site through an interview process.

a. The interview/placement process will begin at a time designated by the program director.

b. The student is free to select a site from the list presented for their first choice. The student may be

competing with other students for that site.

c. Some sites may wish that the selection be made by the school. In this situation, it will be made by luck

of the draw. The student(s) not selected will go into a second stage (outlined in section 7).

d. Once the process begins, the student is expected to schedule their interview within two weeks and

complete it within no more than six weeks (to avoid competition with others at a different placement

stage.) These time frames may be adjusted by the Program Director based on unforeseen circumstances

that may arise during the application process. Special exceptions due to distance may be made,

however, at a sacrifice of what selection round the student returns to if they are turned down by the site,

or they turn the site down.

6. Application for placement:

a. Student must have successfully passed all completed and required courses at the time the list is

distributed.

b. Student must have successfully completed the ARDMS SPI (Sonography Principles and

Instrumentation) exam.

c. Student must have a “C” or better in current Program courses at the time the Program Director

contacts the site to announce the student’s interest.

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d. Students must be free and clear from any school or program probation, academic or otherwise (i.e.

documented attendance concerns). Students may not apply for clinical internship until concerns have

been resolved.

e. At such a time when delays for application for clinical internship have been resolved the student may

chose:

(1) To wait until the beginning of the next stage.

(2) Choose from any available site on the list that currently:

(i) Does not have a student in the current stage applying for it.

(ii) Does not have a student going into the stage applying for it.

f. Applications for placement must be turned in at the designated time directly to the Program Director.

(1) Students failing to return their applications within the designated time frame will not be allowed to

apply to a site that another student has applied to. They may select another site without waiting

for the next stage in the placement process.

7. Placement stages:

a. First stage occurs after the list is initially handed out. The Program Director will designate the amount

of time that the students have to select one site, as their first choice.

b. The student will be given the name of the contact for that site. They will have two weeks to arrange their

interview date. This time frame may be adjusted by Program Director based on the unforeseen

circumstances that may arise during the application process.

c. If more than one student selects the site, they will be competing for the position, unless the site requests

it be done by a draw.

d. Students not selected or decided to turn the site down move to the next stage of the selection process.

Students in the later stage may not compete for a site against a student in the previous stage, unless

the Program Director deems that those in the previous stage have taken too long to arrange or

complete their interview as set forth in section 5.d. of this policy.

e. Once all students have completed the current stage (1st, 2nd, etc.), the process starts over at 6.a., for

those who were not selected or chose to turn down the site. The site list will consist of those sites that

do not have a student in place. Special exceptions may be made when someone who is at a later stage

may be allowed to select another site prior to everyone completing the current stage.

f. Once students have confirmed placement, those sites are closed. Students may not reapply for a site

that may become available due to the fact a selected student is not going on to their clinical internship.

g. In the situation of multiple sites in one city and there are an equal or fewer number students wanting that

city, the program director may suggest a site to a student in an attempt to better match the student’s

personality with what they know of the site’s personality. This may be done to insure the best clinical

experience for all students.

8. The student will need at the time of submission of first choice:

a. A cover letter appropriate to the selected site.

b. A current resume`.

c. Three letters of recommendation (from other than their program specialty advisors.)

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Policies and Expectations in the Ultrasound Lab:

A locker with combination lock will be assigned to you for the semester by your instructor. o Locker may be shared with other designated students. o Book bag, if fits, is to be stored in locker or on floor, not in walk way. o Keep valuables in locker. o Instructors may inspect lockers at any time.

Cell phones shall be silenced or turned off. Cell phone use is prohibited in the ultrasound lab unless specifically permitted by the instructor.

Use of phone on desk without permission is prohibited.

Desk and designated file cabinets are off limits to students.

Clothing: o All clothing shall be neat and clean, reflecting expectations of healthcare professionals. o DMS program dress code shall be followed. o Southeast Tech nametag must be worn. o Closed-toe shoes and socks must be worn in the lab. No ‘slippers’ or boots are permitted. o Shoes are to be worn at all times unless volunteering as the patient. o No caps may be worn during lab.

Scanning may not be performed in the lab without Southeast Tech staff personnel present.

Machines and probes may only be used after appropriate instruction and authorization from instructor.

No unauthorized scans may be performed.

Children are not allowed in the lab at any time.

Hands must be washed upon: o Entering lab as sonographer or patient o Before and after scanning each patient.

Students will wear exam gloves when performing scans.

Instructor must be informed of any latex allergies.

Students will use proper body mechanics in all aspects of performing ultrasound exams.

Student conduct will be professional at all times.

Any student displaying unprofessional behavior may be immediately dismissed from the lab/class and further disciplinary action may occur.

Students who report to class/lab after the consumption of alcohol or other drugs are subject to suspension/expulsion; administration will be notified.

Food and beverages are not allowed in the scanning rooms.

All accidents or injuries, no matter how minor, must be reported to SOUTHEAST TECH staff supervising the lab immediately.

Unobstructed access to all exits must be maintained.

All coats must be hung in HC 111 entryway coat rack.

Ultrasound exam room doors are to be open during scanning.

“Patients” are to be appropriately covered/clothed at all times.

All laundry must be kept off the floor.

Student laptop computer use in the ultrasound lab shall be limited to reviewing scans exported on DI COM, or as otherwise designated by the instructor.

Students will abide by the guidelines for signing up for specific lab times. (posted in lab)

While in lab, student scanning should finish at 10 minutes to the hour to allow for proper room turnaround. Reserved scanning rooms will be released for other students if the reserving student fails to arrive by 10 minutes after the hour.

Equipment: o Transducers and cords should be inspected for damage prior to each scan. o Care must be taken with all cords on the machines that they are not pulled on or run over. o Machine, transducers, cords, EKG wires and bedside table must be cleaned after each scan.

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o Any equipment malfunctions must be immediately reported to Southeast Tech staff supervising the lab.

o All cords and cables must be placed so as to be above the wheels of the machine. o Gel bottles must be refilled and returned to proper cupboard. o Gel bottles removed from warmer should be replaced with a new full bottle from cupboard. o Used linens shall be replaced with clean linen after each use.

Laundry duty:

When assigned laundry duty, laundry must be done and put away every day.

The person assigned laundry duty is responsible for the laundry for that day, regardless if trading has occurred.

If assigned laundry duties are not completed, an additional day will be assigned.

Typical Ultrasound lab hours may be 7am-8pm except on Fridays lab closes earlier.

Laundry should be checked and kept up with on an hourly basis.

The washer and dryer must not be overloaded. o Laundry procedures posted in laundry room shall be followed.

Anything unusual or malfunctioning of the washers or dryers shall be reported to the instructor or lab specialist in HC 111.

This document provides the typical requirements of a sonographer and/or student sonographer in order to

enhance understanding of the professional position, its responsibilities, working conditions, and to help make a

more informed decision about pursuing this career. If you have further questions, please contact a program

instructor.

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RELEASE FORM FOR VOLUNTEERS FOR HEALTH CARE LABORATORY

PROCEDURES - ULTRASOUND

I, _________________________________________________________, volunteer to be a “patient” for

Any Student enrolled in the DMS / Cardiac / Vascular Ultrasound Program.

I understand that acting as a patient in this laboratory may require disrobing, and procedures involved in this laboratory

may be performed by a male or female student in this program.

I understand and expressly agree that my participation as a “patient” for procedures in this laboratory is voluntary, and I

will not receive reimbursement. If I am a student, I understand and expressly agree and consent that my participation or

lack thereof will not affect my grade. I further understand that this procedure will not result in a diagnosis or record, and I

expressly agree that I will not rely or seek to rely upon the procedures in this laboratory as any indicator of my health.

Rather, if I have any health concerns, I will consult with my own medical care provider.

I HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the Southeast Technical Institute, the Sioux

Falls School District, the State of South Dakota, or any of their officers, agents, servants, employees, assigns, or

successors, or any students of the Southeast Technical Institute, from any and all liability, claims, demands, actions or

causes of action arising out of any damage, loss or injury to my person or my property or resulting in my death, while

participating in the activities contemplated by this RELEASE, whether such loss, damage, or injury is caused by the

negligence of the Southeast Technical Institute, the Sioux Falls School District, the State of South Dakota, or any of their

officers, agents, servants, employees, assigns, or successors, or any students of the Southeast Technical Institute, or

from some other cause.

I HEREBY EXPRESSLY ASSUME FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR

PROPERTY DAMAGE that I may sustain while participating in the activities contemplated by this RELEASE, caused by

the negligence of the Southeast Technical Institute, the Sioux Falls School District, the State of South Dakota, or their

officers, agents, servants, employees, assigns, or successors, or students of the Southeast Technical Institute.

I HAVE READ AND VOLUNTARILY SIGN THIS RELEASE AND WAIVER OF LIABILITY and I further agree that no oral

representations, statements of inducement apart from the foregoing written agreement have been made.

This release form is good as long as I am a Southeast Tech student in one of the ultrasound programs.

_______________ ___________________________ ___________________________________

Date Printed name Volunteer Signature

_______________ ___________________________ ___________________________________

Date Printed name Witness Signature

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AUTHORIZATION TO RELEASE INFORMATION

I authorize the instructors of the program at Southeast Technical Institute in which I am enrolled to provide the following information to prospective clinical sites/employers:

1. School/program activities 2. Degrees, Awards, Certificate of Completion 3. Most current GPA/most current program GPA 4. Synopsis of clinical/internship experience 5. Information regarding attendance and behaviors in clinical/internship experience 6. Recommendation for employment

I acknowledge that I have read the Diagnostic Medical Sonography Program Policy handbook and understand the general physical requirements, behavioral requirements, working conditions and job duties typically associated with the Medical Sonography profession. I understand the program policies as they relate to my area of education. In signing this policy statement, I hereby agree to abide to all policy requirements and program rules. ___________________________________ ______________________ Print Student Name Date ____________________________________ Student Signature ______________________________________ ______________________ Instructor Signature Date

This authorization will be preserved in your program student file.